|
APPLICATION OF LONG LEG C
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
8229345
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$158.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$328.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$111.93
|
|
|
APPLICATION OF LONG LEG C
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
8229345
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$158.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$287.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.93
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
8229355
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$164.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$297.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$116.03
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
8129325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$668.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
8129325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.75 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Humana ChoiceCare |
$248.30
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$573.00
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$840.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$238.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$477.50
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
8229355
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$164.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$340.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$116.03
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
8229365
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
8229365
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$3,473.86
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.61 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: First Health Workers Compensation |
$2,235.43
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,580.61
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
8229435
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
OP
|
$537.40
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
9629435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.71 |
| Max. Negotiated Rate |
$510.53 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$322.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$322.44
|
| Rate for Payer: Cash Price |
$322.44
|
| Rate for Payer: Cigna Commercial |
$456.79
|
| Rate for Payer: First Health Commercial |
$483.66
|
| Rate for Payer: First Health Workers Compensation |
$207.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.66
|
| Rate for Payer: GEHA Commercial |
$429.92
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.66
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$489.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$376.18
|
| Rate for Payer: One Health Plan PPO/POS |
$483.66
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.53
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$403.05
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$214.96
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$146.71
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
8229435
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
8729435
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
IP
|
$537.40
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
9629435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.71 |
| Max. Negotiated Rate |
$510.53 |
| Rate for Payer: Cash Price |
$322.44
|
| Rate for Payer: Cigna Commercial |
$456.79
|
| Rate for Payer: First Health Commercial |
$483.66
|
| Rate for Payer: First Health Workers Compensation |
$207.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.66
|
| Rate for Payer: GEHA Commercial |
$376.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.66
|
| Rate for Payer: Multiplan All |
$489.03
|
| Rate for Payer: OMNI Networks Commercial |
$376.18
|
| Rate for Payer: One Health Plan PPO/POS |
$483.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.53
|
| Rate for Payer: Three Rivers Provider Network All |
$403.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.78
|
| Rate for Payer: Zelis Auto |
$214.96
|
| Rate for Payer: Zelis Worker's Compensation |
$146.71
|
|
|
APPLICATION PATELLAR TENDON BEARING CAST
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
8729435
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9629445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$673.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
20300037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9629445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$577.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$769.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
20300037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
1900037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$585.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$780.80
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$888.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$390.40
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$266.45
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
1900037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| Rate for Payer: Multiplan All |
$888.16
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.68
|
| Rate for Payer: Zelis Auto |
$390.40
|
| Rate for Payer: Zelis Worker's Compensation |
$266.45
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8229445
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8229445
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
20300113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
1929425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: First Health Workers Compensation |
$271.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$191.65
|
|
